Clinical InvestigationAcute Ischemic Heart DiseaseReal-world outcome from ST elevation myocardial infarction in the very elderly before and after the introduction of a 24/7 primary percutaneous coronary intervention service
Section snippets
Study population
Consecutive patients aged ≥80 years admitted between March 2003 and March 2008 inclusive with a diagnosis of STEMI to 2 affiliated hospitals: one a large tertiary cardiac center, the other a district general hospital (DGH) in the same city. Patients were identified by retrospective analysis of our institutional database cross-referenced to a comprehensive United Kingdom myocardial infarction database (MINAP [Myocardial Infarction National Audit Project]).
Reperfusion treatment
Patients were divided into 2 cohorts
Baseline characteristics
A total of 256 patients (mean age 85 [range 80-97], 59% female, 97% white) were included in the analysis, 95 in the historical cohort and 161 in the contemporary group (Table I). Significantly more of the contemporary cohort were hypertensive (62% vs 47%, P = .03) and hyperlipidemic (34% vs 21%, P = .04). There was a higher incidence of prior MI among the historical cohort (32% vs 21%, P = .05). The incidence of cardiogenic shock was low but was numerically higher among the historical cohort
Discussion
This study found that introduction of a routine 24/7 PPCI service resulted in reduced long-term mortality among patients aged ≥80 presenting with STEMI. Improved outcome was driven by the significant reduction in mortality observed in patients treated by PPCI compared to those treated by thrombolysis.
The very elderly, defined as aged ≥80, represent an increasing proportion of patients admitted to hospital with STEMI, and their outcome is poor, with 30-day mortality of around 30%.12 However,
Conclusions
Introduction of a 24/7 PPCI service resulted in a significant reduction in 12-month and 3-year mortality in patients aged ≥80 presenting with STEMI, driven by superior outcomes in patients receiving reperfusion therapy with PPCI rather than thrombolysis. These data support the application of routine PPCI for the treatment of STEMI in the very elderly.
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Cited by (15)
Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention
2017, International Journal of CardiologyCitation Excerpt :Morbidity and mortality rates in patients with STEMI increase indeed with age; in particular, mortality of older patients is still higher than in younger patients even after implementation of an infarction network [5,7]. According to current guidelines of the AHA/ACC [14], patients with STEMI presenting within 12 h from symptom onset should be treated with reperfusion therapy; pPCI seems to be the most effective and safe reperfusion strategy in elderly patients with STEMI, but few data describe the subgroup of the oldest old [2–4,8,20–22]. Although there is a great interest in elderly population, the majority of studies considered indeed 75 years as age cut-off while the treatment and outcome of very-old patients (over 85 years old) are still poorly analyzed.
Predictors of long-term (10-year) mortality postmyocardial infarction: Age-related differences. Soroka Acute Myocardial Infarction (SAMI) Project
2015, Journal of CardiologyCitation Excerpt :Moreover, there were significant disparities in the prediction strength of numerous risk factors, most of whom have stronger associations with long-term mortality in the younger group. Although the age used for the definition of older or elderly patients varies among trials from 55 to 80 years [8,20–22], standard WHO definition of 65 years, reflecting also the most common retirement age in Europe, was applied for this study. Baseline characteristics of our entire cohort, the characteristics of the older patients specifically, and the higher prevalence of women, NSTEMI, comorbidities, and risk factors in the older population are consistent with other similar cohorts of “real life” patients, applying similar age definitions [7,10].
Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease
2015, American Journal of CardiologyCitation Excerpt :Meanwhile, life expectancy and quality-of-life assessment in this patient group is complex in the acute setting. Therefore, frailty and age should not prohibit immediate invasive management, as pPCI also in the very elderly (>80 years) improves prognosis.14,15 We found that 30-day mortality in patients with STEMI with EMS-witnessed OHCA was similar to invasively treated patients with STEMI without OHCA, which stresses that advanced life support can safely be performed “en route” to a pPCI center.
Acute glucose dysmetabolism in the elderly with ST elevation myocardial infarction submitted to mechanical revascularization
2012, International Journal of CardiologyCitation Excerpt :Claessen et al. [8] recently reported an increasing proportion of octogenarians treated with primary PCI from 1997 to 2007, who showed increased short and long-term mortality when compared to younger patients. This finding is in keeping with earlier clinical trials such as GISSI-2 and GUSTO-1 [9,10] as well as with previous studies in the era of mechanical revascularization by others [11–16] and us [17]. Several factors can account for the unfavorable outcome of the elderly: structural and functional changes in the cardiovascular system with aging, atypical symptoms (inducing a delay in seeking medical care) and higher co-morbidities, including increased glucose values.
Update on geriatric cardiology
2011, Revista Espanola de CardiologiaRelative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction
2019, European Heart Journal: Acute Cardiovascular Care